Headache and/or Neck Pain in Preadolescents: correlation between pain scale ratings and disability in activities of daily living

Headache and/or Neck Pain in Preadolescents: correlation between pain scale ratings and disability in activities of daily living

Sue Weber BSc, DC, MSc

BACKGROUND: Parental report and child self-report of pain have been found to differ significantly. Preadolescents have the ability to understand pain scales, rate their pain and describe their limitations in activity due to pain. The ”gold standard” for assessing health related parameters is self-reports.

OBJECTIVES: To establish if:

there were differences between how children rate their pain on a numerical rating scale and how their activities are limited due to pain;

these differences contribute to the discrepancy in reporting between children and parents.

DESIGN: A cross-sectional observational study among pre-adolescent students in Sweden.

METHODS: Students from a Swedish municipal school (n=131) aged 10-13 years were asked to participate in a study about neck pain and/or headache. Students with neck pain and/or headaches were asked to complete the questionnaire. Students used the 11 point Likert scale to measure their pain when it is the worst, and the pain they ”usually” have. In a separate question, students were to pick from a list how they were affected when they had pain. They could choose more than one option. The responses they could choose from were the following: I am able to do everything, it doesn’t bother me; I am only aware of it if I think about it; I feel it all the time but I can do my usual activities; It is difficult to concentrate, I can only do easy activities; I am able to participate, but only to half my capacity; I am unable to participate in activities; I must lie down; I have missed school.

RESULTS: Students reported for usual pain intensity during episodes, 5 was the middle value, 6 was the most common answer; for the worst episodes, 7 was the middle value and 7 was the most common answer. Not all students with neck pain/headache filled in this question. Children rated their average pain intensity on the Likert scale 4.02 with SD 2.38. The degree of disability children experienced with neck pain/ headache was investigated by asking how it affected their activity level. Children could choose more than one answer. Nearly 30 % (n=15) said they were able to do what they wanted, and that it didn’t bother them. 18.7 % (n=10) said they could feel it all the time, but they could do what they usually do; 12.5 % (n=7) felt pain when they thought about it; 7.8 % (n=4) said they had difficulty concentrating; 7.8 % (n=4) said they could only participate in activities at half speed; 10.9 % (n=6) reported they felt so bad they couldn’t participate in activities; 12.5% (n=7) wrote that they had so much pain they had to lie down; and 7.8 % (n=4) had missed school because of their neck pain/headache. Seventy-five percent (n= 39) reported that ADL were not interrupted by pain. Nineteen percent (n=10) reported neck pain/headaches could affect them so that at times they could only partially participate in activities, 13% (n=7)could not at times participate in activities, and 15% (n=8) needed to lie down with severe episodes.

CONCLUSIONS: Students in this study reported having a fairly high level of pain. At the same time, that the majority of the students wrote that the pain they experienced did not interrupt their daily activities. This may contribute to the discrepancy found when comparing parental report and student self report.